Thursday, July 15, 2010

Rest Time

So I finished my summer term and ended up with an A in clinical and a B in theory. Once again, there is just too much information in a short amount of time for me to get the A I wanted in theory.

I am looking forward to some time off from school. I am headed out of town this morning for a few days with my family. I'm sure we will have a good time.

Since I finished my summer term, I've been applying for tech jobs at all of the local hospitals. So far I've come up with nothing. I have to wonder how many people are applying to these jobs. There are so many people like me who want to get into a position like that, yet there really are not that many jobs out there. I was talking to some classmates a few weeks ago who said that they had just been hired and had been applying for positions since March. If this holds true, maybe I'll be able to get something before Christmas.

This fall I'll be taking my Adult semester. I really hope that I can learn a lot. I feel pretty ill-prepared for the nursing world right now. There is so much to learn in order to really be able to help people who are sick. I am amazed at the knowledge that the nurses have that I meet. It makes me wonder if I'm in doing the right thing by going into this field. I have to wonder if I am learning everything that I should be learning. Guess I'll see when I land that first job.

I was surprised to learn that I have been awarded a grant for the fall and spring semesters. Woot! I would not consider myself financially needy, but I'll take the money anyhow. I was thinking that if I applied for financial aid I might be able to come away with a scholarship of some sort or maybe they would offer me student loans. (Student loans are evil BTW) So, the grant was a total surprise. Yes, I'll let the government pay for my education!

On with vacation. When I get back, I'll look into doing some more review in A&P. That can never hurt.

-DV

Monday, July 5, 2010

The Apocalypse

FINALLY!!!!! A patient with some character! WOOT!

Today my rotation sent me to the acute psych unit at the hospital. This is where the patients go to detox, get on their meds, sober up, and come back to reality. I was so glad to finally get to this unit. I was able to get past the three locked doors and into the unit. After finding the charge nurse, she took me on a mini tour of the floor. There was plenty of office space for various physicians, nurses, and meetings. Then I was able to see the patient rooms. I was surprised to see them rooming with other patients; there were 2, 3, or 4 to a room. After the tour, I was just in time to attend the interdisciplinary team meeting. The nurse quickly went over each of the 19 patients and the physicians and social workers took notes. It wasn’t quite what I expected, but it was insightful none-the-less. Then I went to the day room to pick out a patient…

“Gabriel” was a male. He seemed very nice and very open and willing to talk to me. I can only wish that he had been the patient I had spoken with for my process recording. “Gabriel” was an angel sent from God to warn the people of the world that they were evil. He could see the souls of those around him. (I had a good soul, thank-you-very-much.) “Gabriel” went on to talk about some of his grandiose delusions and how he found out who he was only three weeks ago. There was a lot more about his relationship with God and Satan, but there is just too much to put down on paper.

Here’s the thing that really got me. Usually when someone starts making up stories and saying things like this, a person can just tell that it is fiction. You laugh and go on. “Gabriel” IS an angel. He truly believes this. What is difficult to understand is that there is an interwoven mesh of reality and delusion. Much of what he said about people in the world today was based on fact. Some of the statements he made, I would agree with whole heartedly. After a while I was truly captivated by his story. Being a Christian, it was difficult for me not to challenge his theology, but I was good and realized what not to say to him. I really tried to work on my therapeutic communication, and while there were a few blocks, I realized what I had said afterword and tried to stay on track. I feel like I am getting better, but I still have a long way to go.

After lunch I went to look up “Gabriel's” chart to find out what his diagnosis was. Initially he was diagnosed with Bipolar disorder. For a while he was functional and going to school while he was on meds. Then during a matter of a couple of days he crashed. Now he is admitted with schizoaffective disorder. Apparently, the physicians don’t really know what is wrong or what triggered his sudden decompensation. This is the really scary part of nursing for me. What do you do for a person like this? His meds just don’t work anymore. He’s completely delusional and doesn’t seem to be getting better. I spent a lot of time in his chart today trying to find some answers, but came away with almost nothing.

Today was an exciting day in my mental health clinical rotation. However, it was also my last full day for this summer semester. I am really disappointed that I didn’t get to spend more time in the acute setting. This is what I’ve been waiting for all semester and now it’s over. I think it’s a shame that I only get to spend six weeks in a class that is so interesting and relevant to all areas of nursing.

As I mentioned in another blog entry, I’m not sure that I see my self going into mental health. However, I think with more time in the acute care unit I might become more interested in following that path. I have noticed that the staff nurses don’t really do very much. They’re kind of like “Nurse Vending Machines”. They give out the meds when it’s time. They discharge and admit patients while filling out loads of paperwork. There really isn’t very much therapeutic interaction with the patients. I suppose that’s why you would want to go into the practitioner levels of education. If I go into mental health nursing, I’d want to help patients in a more direct manner. I guess only time will tell.

-DV

Saturday, July 3, 2010

Go Towards the Light

There is a light at the end of a short tunnel. Today I finished gathering all of the information I needed to complete my clinical assignments. I’ve got pages of care plan notes, notes from a lengthy conversation I had today for my process recording, and now I’ve got to do something with it all. I’ve got to take this information and be able to present it in such a way that others will know exactly what I want them to know. After the previous four weeks, I’ve found that to be much more difficult than it sounds. Also, like the long semesters, as I near the finish line I tend to get ready to rest a bit too soon. I’m ready for summer break. This will be my first semester off in 1 ½ years. Yea! I’ve just got to push toward the end and complete everything the best I know how.

My day today was good and bad. First, this morning was somewhat of a bust. I went onto my unit to find that ALL of the patients were in group meetings. There was nobody on the floor. I went back to the computer room and worked on gathering some more information for my care plan. Fifty minutes later I went back onto the floor to wait in the day room for the patients to come back. Most of them did not come back because they were going bowling. I ended up “shooting the breeze” with the nurses for nearly two hours. One was the regular staff nurse, but she was pretty busy and had no qualms about telling me so. The other was a new staff nurse in training on that floor. We actually talked a lot. The cool thing was that this nurse was a male nurse. He had been in psychiatric nursing for about thirty years and had worked for the state hospital for quite a while. He had a wealth of knowledge and tons of tips for me as well as some very interesting stories. We discussed what it was like being a psych nurse compared to med-surge, career tips, education, etc. I was really glad that he was so open to passing on information to a rookie. One thing he mentioned was that the units I had been on up to this point weren’t “really” psych units. I have to agree. He said that next week, when I move to the acute care unit, I would really get the experience I was looking for.

After lunch I went back to the unit and waited for some unsuspecting person to come into the day room. I had to wait about ten minutes when finally a gentleman come in and sat down with a magazine. I mustered up my courage and went over to him and started up a conversation. He was pretty receptive to me. Our conversation lasted about an hour and a half. Therapeutic communication is difficult for me. I caught myself saying things that were not working to help the patient express his feelings. Occasionally something good would come out, but this is really difficult for me. I don’t mind listening, but making me try and say something worthwhile takes work. Speaking of making me say something worthwhile…

A couple days ago I was “encouraged” to participate more in class – as were many of my other classmates. My brain doesn’t work that way very well. It takes every ounce of energy that I have to muster up questions to ask about presentations. The questions I ask on the spot are generally superficial and don’t seem to bring up important issues. I’d much rather have time to think about questions and ponder what has been presented to me. I suppose that is part of becoming a nurse. Being able to think critically in a short amount of time is very important. I’m going to have to practice that as well.

I hope that my last two days in clinical prove to be very educational. I’m looking forward to practicing my skills more without the looming report deadlines. It’s time to get ready for the big finish. I hope I go out with a bang.

-DV

Friday, July 2, 2010

Life's a B**ch

Today was my first clinical day in the main psych building. I was ready to get out of the outpatient unit. My goal today was to get as much done as I could for my assignments that are due next week. I wasn’t too sure how I would do. I went into the short term unit. Here patients are allowed to come and go from the unit. They are also allowed day passes when merited. I was just a little apprehensive going into the unit for the first time. Fortunately, I was able to fine a patient easily and interview him. My goal with this patient was to conduct my interview so that I would be able to complete my care plan and mental health assessment. After talking to my patient for about an hour, he had to leave for a group meeting.

I must say that I was appalled at what he had to go through. There is no wonder he has problems in life. His main reason for being in the hospital is prescription drug addiction. I am quite surprised that this is his chief problem. His father died while he was a baby, his mother was an alcoholic and a drug abuser, his uncles were no better than his mother. My patient was basically raised by his “loving” grandmother who beat him with water hoses and tree branches. His uncles would make him high from marijuana before he even started kindergarten. He started smoking marijuana when he was in middle school. That also led to alcohol and cocaine/crack abuse later on. His best friends killed themselves and he now has no family in his support group. What kind of sick people do this to their child? It is really disgusting to know that there are people in the world who do this to children.

Considering his background, I’m amazed that he is still alive. He does have hopes of becoming a healthcare worker someday, as he was a medic in the army. I don’t know that he will ever be allowed to enter the profession, but he sure would have an amazing and inspirational story if he did.

I was able to get all of the information that I needed for my assignment. That’s good. I spent much of the remainder of the day working on the care plan.

I was wondering today what my future holds for me. I am really enjoying mental health nursing. The disorders we are studying are really fascinating; however, I’m not sure that I feel truly drawn to this particular field of study within the nursing profession. I thought I would be, but that hasn’t happened yet. Honestly, I feel like I’m just waiting for something to really inspire me. Right now it’s as if I’m simply scratching off the options that I know I don’t want to do and I’ll see what’s left. (Process of elimination.)

Tomorrow I will be on the same unit. I’ll work specifically on my process recording. I’m a little worried about this one because it’s all about therapeutic communication. Today, I noticed that I was asking a lot of closed ended questions. That’s not good. I think I’ll feel better if I go back and review a couple chapters on communication. That will make me feel better…maybe.

Only 1 and ½ weeks left for clinical. It’s going by very fast and I don’t feel like I’m able to learn everything I need to learn. Degrees are funny that way. There is an infinite amount of information to be learned, yet there is a VERY finite amount of time to learn it.

-DV

Wednesday, June 30, 2010

Third Time’s a Charm

I wasn’t too sure what to expect today in clinical. Today was supposed to be a “Community Integration” session; however, it happened to be the third Tuesday of the month a Patient’s Government meeting was held instead. The Pt's are allowed to manage their activities and leisure space as they wish, so once a month they hold parliamentary procedures to discuss what will happen during the next month. Sounds exciting, right? Zzzzzzzzzzzzzzzzz I suppose it was good to see how the patients are able to interact with each other, but I was really hoping to see more today. I had to really work to try and stay alert during this meeting. I have to admit that after today I’ll be glad to move to a more acute setting in the main hospital.

After the government meeting I was able to interact with the patients before lunch…

Patient No. 1: An old man in a wheelchair.
DV: “Hello, my name is DV. I’m a student nurse. Would you mind if I sat down and spoke with you for a few minutes.”
Patient No. 1: “I DON’T WANT TO BE BOTHERED RIGHT NOW!”
DV: Welllllll okay then, maybe later.
Okay, so maybe he wasn’t the best person to approach since he was quite the complainer during the previous meeting. I really thought he would have an interesting story. Strike one for the student nurse.

Patient No. 2: Middle aged African American man.
DV: “Hello, my name is DV. I’m a student nurse. Would it be alright for me to sit and talk with you for a while?”
Patient No. 2: Yes.
DV: Great. (Reaches over to grab a chair)
Patient No. 2: “I gotta go get my gla%$%^&**&^&*^%$#$” (Stands up and runs away, never to be seen again.)
DV: (Perplexed) Um, okay.
DV: (To Student Nurse #2 who saw the whole thing) “Didn’t he just say it was okay if I sat down with him?”
Nurse #2: “Yes.”
DV: “Did…um…did he just run away from me as fast as he could?”
Nurse #2: “Um, yes.”
DV: “WTF?”
Nurse #2: “Well, DV, you are kind of intimidating.” (Laughs)
DV: (Sarcastically) “Oh, right….”
Strike two for the student nurse.

Patient No. 3: Middle Aged African American male (A different guy of course.)
DV: “Hello, my name is DV. I’m a student nurse. Would it be alright for me to sit and talk with you for a while?”
Patient No. 3: “You’re sitting right here next to me. Might as well.”
DV: Don’t run away okay.
Patient No. 3: Um, okay. You alright kid?
CONVERSATION CONTINUES AD LIBITUM.

Okay, so I embellished the third patient a little, but the first two were dead on. FYI, this does not make me want to walk up to crazy people and just start talking to them. Must…keep…trying….

DV

Tuesday, June 29, 2010

Study Hall Today

Today’s clinical session was good and bad in various ways. I was pretty pumped up about going into the outpatient site today and talking to patients. I was just going to go in and do it. After arriving on the unit we found out that today was “Community Integration” day. Hmmm, what’s “Community Integration”? As it turns out, it is basically a field trip for the outpatients. They were going to go see a movie. After finding out that the student nurses would not be accompanying the patients on their outing (quite frankly, I wasn’t too keen on that idea anyway) we decided to find someone and interview them real quick so that we would have information to write a care plan. I went into the community room and found a “patient” that I was able to have a brief conversation with. I felt rushed and the setting was not very good. The coordinator of the outing interrupted a couple of times to make general announcements. I’m not sure how well I really did on my interview of this patient, but I did get some basic information from him. This was the extent of my patient interaction today. Yep, it was a bit of a bummer.

After talking to my patient, my colleagues and I went back to the meeting room and proceeded to work on our care plans. In some ways this was a good thing. I needed to get my first care plan turned in for critique and I wasn’t going to have a lot of time when I got home that evening. By the end of the day I was able to get something turned in. It wasn’t my best work because I wasn’t able to really research everything like I would have had I been at home. Nevertheless, I was able to turn something in.

Before lunch we were able to practice our therapeutic communication skills while role playing. This was a real eye-opener for me. I had gone through some of this in my head on occasion and it always seemed so natural. When I was sitting in the hot seat however, it was if my mind just went blank. I couldn’t help but think of Mavis Beacon’s “Typing Tutor” (just go with me here). On this computer typing software there is a game where you are driving a car and every time you make a typing mistake, a bug hits your windshield. By the time I had finished my “therapeutic communication”, I had bugs all over the place – closed-ended questions flying left and right, giving approval, agreeing, changing the subject – all over the place! By the end I finally started getting the hang of it and was able to present some good communication skills. I was apprehensive about doing this at first, but it was a really good learning experience. Hopefully I’ll get better.

Overall today was just okay, but it was productive (just not quite what I had expected). I really hope tomorrow will be better. I need some excitement in this rotation. It would be awesome if I was able to witness just one major meltdown before the end of this semester.

-DV

Thursday, June 10, 2010

Testing the Waters vs. Jumping In

Today was the second day of clinical. We took a tour of the mental health unit of the hospital and finished going through most of the CID. I’m not too sure if I was just tired today or if things just didn’t go as well as I had hoped - probably a little of both. I woke up early again this morning and went for another run. I really enjoy waking up early before the rest of the family. It gives me some time to be by myself during the day. I loved the train ride this morning. I was able to get quite a bit of studying done without the frivolous talk of deadbeat husbands, girdles and such. :) (Sometimes it really sucks to be the token male.) I arrived at the hosptial nearly an hour early and went on up to the meeting room just in case it was already open. Nope. Next week I’ll hang in the cafeteria or waiting area when I get there. The air was still out so I knew it was going to be another uncomfortable day. Now that I think about it, maybe that [the heat] just started things off on a downward slope.

I knew that I would be sent out into one of the units today, but I’m not too sure what I expected. Actually, I do know. I expected to be able to test the waters today, and I did. However, we don’t have time for that. As it turns out, in order to get everything done that needs to be done during the next four weeks, I’m going to have to just take a deep breath, jump in and hope that I can swim. I feel like I’m already behind in what I needed to be doing today. My first unit assignment was in the recovery group building. What should have happened is this. I should have gone into a group, identified a patient and followed up with that patient ASAP. I didn’t. Did I think about it? Yep, sure did. Was the opportunity there? Yep, sure was. The thing that comes to mind here is that whole “Self Directed Learner” thing all the faculty have been telling us about. I was too apprehensive after the first meeting to seek out that opportunity to practice my therapeutic communication skills. As it turns out, the patient I had chosen attended both group meetings today. She was there in the building and all I had to do was seek her out. Had I left the first meeting and gone to interact with the patient(s) I could have developed an introductory relationship with at least one of them. During the second meeting I had decided to seek out my “chosen” patient afterword. Wouldn’t you know it; she left the second meeting early. Two things happened when my chosen patient walked out…

1. The outward emotion, “Oh, man, she’s leaving. I didn’t get a chance to talk to her.”
and
2. The inward emotion, “Oh, thank God. Now I don’t have to talk to her.”

I’ve come to the realization that this sort of behavior is fairly typical of me. Maybe that’s normal, maybe not. What I do know is this, if I don’t take the initiative to “practice” my skills, I won’t do well in this class. I have to do things in this particular nursing rotation that are directly contrary to my personality. I am not a social person, but I will have to start pretending pretty soon before I start to sink….. [sigh].

So now, after having spent a couple of hours looking at my patient’s chart, I’ve got all of the necessary, fact finding, theoretical, organizational, research work done. I can tell you what’s wrong with her, what meds she’s taking, her delusional statements, her physical needs, etc. What I don’t have is the necessary information I need to actually help this person. What is that information? It’s her tone of voice.

-DV